Communication of perioperative anaphylaxis under general anaesthetic to patients and within the multidisciplinary team

Abstract

Background: Anaphylaxis is defined as a severe, life-threatening systemic hypersensitivity reaction. Its incidence is estimated to be 1 in 10 000 anaesthetics.1 The 6th National Audit Project (NAP6) on perioperative anaphylaxis revealed that one-third of patients experienced harm after the event, with anxiety about future anaesthetics being the most commonly reported consequence. The objective of this study is to assess the effectiveness of (1) communication of perioperative anaphylaxis and (2) emotional support provided to patients, and their consequent impacts on feelings towards future anaesthetics. This study also evaluates the current procedure for allergy referral after perioperative anaphylaxis. Methods: Thirty-four patients who experienced general anaesthetic-induced perioperative anaphylaxis in Addenbrooke’s Hospital, Cambridge between 5 January 2017 and 2 December 2020 were identified using electronic medical records. The subjective experiences of the communication of the anaphylactic event and the allergy testing results were evaluated in a telephone survey of 26 of these patients. The telephone survey also explored patients’ perception of the emotional support received after anaphylaxis and any negative impact on their feelings towards a subsequent general anaesthetic. In addition, the responsible person for making an Allergy department referral in all cases was investigated. Results: Communication of the anaphylactic event was considered excellent by 69% of patients, with a rating of 5/5 on a 1–5 rating scale. Of the 17 patients that were referred to the Allergy department for allergen testing, 16 felt communication of the test result was clear. Emotional support from hospital staff after anaphylaxis was considered excellent by 38% of patients, whereas 33% felt emotional support was poor on a 1–5 rating scale. Negative feelings towards a subsequent general anaesthetic were reported by 50% of patients. There is also a lack of consistency regarding who makes an allergy referral (surgeon or anaesthetist). Conclusions: The study data show that improvements in the process of referring patients to the Allergy department, and patient experience in terms of communication and emotional support after a traumatic anaphylactic event, should be made. This is in concordance with the findings of the NAP6 report. There need to be clearer local guidelines regarding which clinician is responsible for making an anaphylaxis referral to the Allergy department. Patients should be sent a letter explaining their anaphylaxis, the significance of it and the sources of support available if required. Anaesthetists and the Allergy department should be made aware of emotional support available to recommend to patients. We have presented our findings to the Anaesthetics and Allergy departments of Addenbrooke’s Hospital and are in the process of making changes to the practice. We will review again in 3–5 years’ time. 1.Harper NJN, Cook TM, Garcez T, et al. Br J Anaesth 2018: 121: 159–71